Measuring the neighbourhood using UK benefits data: a multilevel analysis of mental health status

Background  

Evidence from multilevel research investigating whether the places where people live influence their mental health remains inconclusive. The objectives of this study are to derive small area-level, or contextual, measures of the local social environment using benefits data from the Department of Work and Pensions (DWP) and to investigate whether (1) the mental health status of individuals is associated with contextual measures of low income, economic inactivity, and disability, after adjusting for personal risk factors for poor mental health, (2) the associations between mental health and context vary significantly between different population sub-groups, and (3) to compare the effect of the contextual benefits measures with the Townsend area deprivation score.     

Local neighbourhood and mental health: evidence from the UK

This paper examines the association between neighbourhood and levels and changes in common mental disorders. Using data from a large scale nationally representative survey of individuals and households (the British Household Panel Survey), it locates individuals in their local neighbourhoods. These are defined as the nearest 500-800 persons centered around each individual in the survey. These 'bespoke' neighbourhoods are characterised according to five dimensions--disadvantage, mobility, age, ethnicity and urbanness--derived from factor analysis of the census characteristics of the residents of neighbourhoods in 1991. These dimensions measure characteristics of place that have been argued to be associated with mental ill health. The paper estimates multilevel models of the level and 5-year changes of common mental disorders (measured by the twelve item version of the General Health Questionnaire). Three and two level models are estimated, all of which allow for individual and household characteristics that may act as confounders of any neighbourhood effect. The results show the extent of association between neighbourhood and both levels and changes in mental health is limited. Less than one percent of the variance across individuals is at the neighbourhood level. The neighbourhood characteristics are not generally statistically associated with levels or changes in mental ill health. There is some evidence of interaction between neighbourhood characteristics and gender and ethnicity, but while statistically significant these interactions are small in size compared to the main effects of individual and household characteristics. What appears to be important for levels of common mental disorders are the observed characteristics of individuals and their households, not of place.     

The health consequences of multiple roles at older ages in the UK

Increasing proportions of men and women are combining family (including care-giving) and work responsibilities in later life; however, the relationship between multiple role commitments and health at older ages remains unclear. Employing data from the longitudinal Retirement Survey (1988-1989 and 1994), the present authors applied logistic regression models to investigate the relationship between multiple role occupancy (1) cross-sectionally in 1988-1989 and health status in 1994; (2) retrospectively over the respondent's lifetime up to 1988-1989 and health outcomes in 1988-1989; and (3) retrospectively between 1988-1989 and 1994, and health status in 1994. The health outcomes considered were (1) general health status, (2) functional ability and (3) severity of disability category. Overall, simultaneous role occupancy (e.g. care-giving and employment) at older ages does not appear to be associated with poor health. The authors report a positive association between employment and health, as expected. There were mixed results concerning the association between care-giving and health. Where adverse health outcomes were found, the parental role, alone or in combination with other roles, was most frequently related to poor health. Thus, for a nationally representative sample of mid-life men and women, the combination of care-giving with other family and work roles appears to have few negative health consequences. Further research is needed on whether continued parental demands in mid-life have a negative impact on health.     

Selective migration, health and deprivation: a longitudinal analysis

Population migration is a major determinant of an area's age-sex structure and socio-economic characteristics. The suggestion that migration can contribute to an increase or decrease in place-specific rates of illness is not new. However, differences in health status between small geographical locations that may be affected by the inter-relationships between health, area-based deprivation and migration are under-researched. Using the Office for National Statistics (ONS) England and Wales Longitudinal Study (LS) 1971-1991, this research tracks individuals to identify any systematic sorting of people that has contributed to the area-level relationships between health (limiting long-term illness and mortality) and deprivation (Carstairs quintiles). The results demonstrate that among the young, migrants are generally healthier than non-migrants. Migrants who move from more to less deprived locations are healthier than migrants who move from less to more deprived locations. Within less deprived areas migrants are healthier than non-migrants but within deprived areas migrants are less healthy than non-migrants. Over the 20 year period, the largest absolute flow is by relatively healthy migrants moving away from more deprived areas towards less deprived areas. The effect is to raise ill-health and mortality rates in the origins and lower them in the destinations. This is reinforced by a significant group of people in poor health who move from less to more deprived locations. In contrast, a small group of unhealthy people moved away from more deprived into less deprived areas. These countercurrents of less healthy people have a slight ameliorating effect on the health-deprivation relationship. Whilst health-deprivation relationships are more marked for migrants there are also health (dis-) benefits for non-migrants if their location becomes relatively more or less deprived over time. Overall we found that between 1971 and 1991, inequalities in health increased between the least and most deprived areas, compared with the health-deprivation relationship which would have existed if peoples' locations and deprivation patterns had stayed geographically constant. Migration, rather than changes in the deprivation of the area that non-migrants live in, accounts for the large majority of change.     

Effects of changing exposure to neighbourhood greenness on general and mental health: A longitudinal study

Green neighbourhood environments have been associated with physical and psychological wellbeing in adults. Access to greenness is potentially more important in vulnerable subgroups. In this study based on longitudinal survey data from southern Sweden the cohort was divided into prognostic groups for good self-reported general (n=8891) and mental (n=9444) health. We used independent survey data to assess perceived neighbourhood greenness in 1 km² areas, and estimated effects of changing exposure longitudinally stratified by prognostic group. The overall effect on health was small and statistically uncertain (for general health OR 1.04, 95% CI 0.98–1.10, for mental health OR 1.07, 95% CI 1.00–1.14). A more beneficial effect of increased greenness was indicated among subjects with lowest prognostic of good general health (OR 1.24, 95% CI 1.01–1.52). The study provided only weak evidence for beneficial effects of increased neighbourhood greenness triggered by changing residence. It seems that altered life circumstances, e.g. changed civil or socioeconomic status that often trigger a decision to move, are also the key determinants of the health consequences of changing residence.     

Main and interactive effects of inflammation and perceived neighbourhood cohesion on psychological distress: results from a population-based study in the UK

Quality of Life Research - Low neighbourhood cohesion and increased levels of inflammation are independent predictors of psychological distress. In this study we explored if they also interact to...     

A longitudinal analysis of mental health mobility in Britain

This paper is concerned with quantifying the level of mental health mobility in the British Household Panel Survey (BHPS). We investigate whether the extent of intertemporal fluctuations in mental health is different across categories of socio-economic group such as income quintiles, educational attainment and social class. Our measure of mental health is the 12-item version of the General Health Questionnaire (GHQ) that serves as a self-administered screening test aimed at detecting psychiatric disorders. Using 11 waves of the BHPS and a variety of methods we show there is much mobility in mental health from one wave to the next. Further the extent of mobility varies across socio-economic categories with greatest persistence observed in more disadvantaged groups. In general, these groups suffer poorer mental health and experience more periods of ill-health. Our results have implications for the design of appropriate prevention policies targeting mental illness within different risk groups, and also for the measurement of long-term inequalities in mental health across socioeconomic groups.     

Correction to: Main and interactive effects of inflammation and perceived neighbourhood cohesion on psychological distress: results from a population-based study in the UK

Quality of Life Research - The article “Main and interactive effects of inflammation and perceived neighbourhood cohesion on psychological distress: results from a population-based study in...     

Perceived neighborhood social cohesion and subsequent health and well-being in older adults: An outcome-wide longitudinal approach

BackgroundGrowing research documents associations between neighborhood social cohesion with better health and well-being. However, other work has identified social cohesion's “dark side” and its ability to promote negative outcomes. It remains unclear if such diverging findings are attributable to differences in study design, or other reasons. To better capture its potential heterogeneous effects, we took an outcome-wide analytic approach to examine perceived neighborhood social cohesion in relation to a range of health and well-being outcomes.MethodsData were from 12,998 participants in the Health and Retirement Study—a large, diverse, prospective, and nationally representative cohort of U.S. adults age >50. Multiple regression models evaluated if social cohesion was associated with physical health, health behavior, psychological well-being, psychological distress, and social well-being outcomes. All models adjusted for sociodemographics, personality, and numerous baseline health and well-being characteristics. To evaluate the effects of change in cohesion, we adjusted for prior social cohesion. Bonferroni correction was used to account for multiple testing.ResultsPerceived neighborhood social cohesion was not associated with most physical health outcomes (except for reduced risk of physical functioning limitations and better self-rated health) nor health behavior outcomes (except for more binge drinking). However, it was associated with numerous subsequent psychosocial well-being (i.e., higher: positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; reduced likelihood of infrequent contact with friends) and psychological distress outcomes (i.e., lower depression, hopelessness, negative affect, loneliness) over the 4-year follow-up period.ConclusionsWith further research, these results suggest that perceived neighborhood social cohesion might be a valuable target for innovative policies aimed at improving well-being.     

Quality of life, health and physiological status and change at older ages

The relationship between self-reported health status and quality of life at older ages is well established. The present paper investigates this relationship further, using objective measures of health and their change over time in the English Longitudinal Study of Ageing, where positive quality of life at older ages was measured as CASP-19. Cross-sectionally, lung function and obesity, but not blood pressure, were associated with quality of life; these relationships in path analysis were transmitted primarily via functional limitation and more modestly, and only for lung function, via clinical depression. Longitudinally, the results suggest a stable and long-term influence on quality of life of lung function and, among women, body mass index, to which the influence of change may be cumulative; longer follow-up is required to clarify these processes. Overall, the results show that the relationship between health and quality of life is independent of potential psychological confounders, that functional limitation is the key dimension of health in its relationship with quality of life and that clinical depression may be an important mediator between functional limitation and quality of life.     

Relationship between neighbourhood social participation and depression among older adults: A longitudinal study in China

Previous research has found a negative linkage between neighbourhood social participation and depressive symptoms in Western countries, but the cross‐sectional design of these studies limits the ability to infer causality. Little attention has been paid to socio‐psychological pathways linking neighbourhood social participation to depressive symptoms among older adults in China. This study aimed to examine the impact of neighbourhood social participation on depressive symptoms among older adults in China. It also further explored the mediating roles of physical activity, social contact among neighbours, and contact with own children in the relationship between social participation and depressive symptoms. Data obtained through three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study were used. The sample consisted of 10,105 individuals aged 60 and above and 24,623 person‐year records captured during these three waves. Depressive symptoms were assessed using the Center for Epidemiology Studies of Depression scale. Results showed that respondents' depression decreased with an increasing level of neighbourhood social participation, more time spent on physical activities, and a higher frequency of contact with neighbours and with own children. These factors were found to partly mediate the relationship between neighbourhood social participation and depression. The negative relationships between social contact and depression and contact with own children and depression were both strengthened by neighbourhood social participation. In conclusion, physical activity, social contact among neighbours and contact with own children are mechanisms through which neighbourhood social participation lowers the risk of depression among older adults in China.     

Work-related internal migration and changes in mental and physical health: A longitudinal study using German data

Work-related internal migration can be associated with various labor market benefits such as improved career opportunities. However, benefits can be offset by specific burdens (relocation stress) which, in turn, can lead to adverse health outcomes. These burdens include organizing the move, difficulties in maintaining social relationships, homesickness or feelings of displacement. However, there is a particular lack of longitudinal studies which deploy advanced methods to examine how internal migration affects shifts in health-related quality of life (HRQOL) over time. Also, there has been little research into whether the consequences of relocations differ by socio-economic position. In order to address these gaps, we apply fixed effects (FE) panel regression models to representative data from the German Socio-Economic Panel (SOEP). We use the SF-12 Health Survey items to capture the subjective assessment of overall mental and physical well-being. Overall, we find an increase in physical HRQOL after the relocation event. Mental HRQOL tends to decrease before the event and then increases afterwards, on average, but there seems to be very little lasting change. Subgroup analyses, however, reveal differential trajectories by educational level, i.e. a clear educational health gradient around migration. While physical and mental HRQOL increases among movers with high educational attainment, individuals with lower levels of education show decreases in both health dimensions upon moving.     

Residential self-selection,perceived built environment and type 2 diabetes incidence: A longitudinal analysis of 36,224 middle to older age adults

Much of the existing studies on the built environment and type 2 diabetes are cross-sectional and prone to residential self-selection bias. Using multilevel logistic regression analysis of 36,224 participants from a longitudinal study, we examined whether perceived built environment characteristics are associated with type 2 diabetes. We found that the odds of diabetes incidence varied geographically. Those who reported that there were no local amenities and reported day- and night-time crime rates made walking unsafe in the neighbourhood had higher odds of developing incident type 2 diabetes. These associations persisted after accounting for some predictors of residential self-selection. More longitudinal studies are needed to corroborate the findings. Changing the features of the residential built environment may be an important point of intervention for type 2 diabetes prevention.     

Effects of perceived job stress on mental health. A longitudinal survey in a Japanese electronics company

We conducted a cohort study for 2 years to examine the causal relationship between perceived job stress and mental health. Questionnaire surveys, including a 30-item General Health Questionnaire (GHQ) and a questionnaire on perceived job stress were carried out every 6 months for 2 years. To clarify the causal relationship between job stress and mental health, we followed a group of workers who initially had a GHQ score 7. Out of 462 workers who were thought to be in a healthy mental state, 282 were successfully followed for 2 years. We considered subjects who developed unhealthy mental health states (GHQ score 8) as hazardous cases. To control potential confounding factors, proportional hazard analysis was done. The overall proportion hazardous cases detected in the development of an unhealthy mental health state over two years was 55.7%. Using Cox's proportional hazard model, workers who complained of perceived job stress had a greater hazard than those without job stress. In particular, the item poor relationship with superior showed the largest adjusted hazard ratio [95% confidence interval (CI)] of 1.51 (1.06–2.15). The item too much trouble at work also had a significant hazardous effect on mental health with an adjusted hazard ratio (95% CI) of 1.43 (1.00–2.04). Some specific items of perceived job stress could cause mental ill health in workers.     

Social capital, community size and utilization of health services: a lagged analysis

Objectives

We examine the relationship between social capital, community size and GP visits, and conceptualize social capital as a stock variable measured at a prior point in time.

Methods

Data from the 2002 Canadian Community Health Survey and the 2001 Canadian Census are merged with GP visit data from the Ontario Health Ministry. Negative binomial regression is used to measure the impact of community-level (CSC) and individual-level social capital (ISC) on GP visits. CSC is measured with the Petris Index using employment levels in religious and community-based organizations, and ISC is measured along multiple dimensions.

Results

The effect of social capital varies by community size. A one standard deviation increase in the Petris Index in larger communities (population > 100,000) leads to a 2.6% decrease in GP visits with an annual offset in public spending of $66.4M. Tangible social support—a measure of ISC—also exhibited large effects on GP visits. In smaller communities (population 10,000-100,000), only increased ISC exhibited an impact on GP visits. Age had no effect on the association between social capital and GP visits.

Conclusions

Each form of social capital likely operates through different mechanisms and impact differs by community size. Stronger CSC likely obviates some physician visits in larger communities that involve counseling/caring services while some forms of ISC may act similarly in smaller communities.     

Children's health-related quality of life,neighbourhood socio-economic deprivation and social capital. A contextual analysis

Neighbourhood objective socio-economic indicators and community-reported subjective measures of social capital were examined in relation to children's health-related quality of life in the Netherlands. Three different data-sources were used: (1) objective neighbourhood socio-economic indicators, (2) subjective neighbourhood data on social capital, and (3) individual data of a family cohort study, including questions on children's health-related quality of life, and family socio-economic status. Multilevel analyses were conducted using both neighbourhood level and individual level data. Neighbourhood socio-economic status and social capital were associated. Measures of socio-economic deprivation and social capital were both non-specifically associated with children's general health and satisfaction, independent of possible individual-level confounders. However, children's mental health and behaviour were specifically associated with one aspect of social capital, the degree of informal social control in the neighbourhood.     

Relative deprivation of assets defined at multiple geographic scales,perceived stress and self-rated health in China

Relative deprivation (RD) may increase psychosocial stress, which could result in poor health. We examined the associations between asset-based RD indicators, defined at multiple geographic scales (i.e., within community; within area (urban/rural) of a province; within province; and across country), and self-rated health in China. A generalized structural equation model was used to estimate both the direct association between RD and self-related health and the indirect association through psychological stress measures. Results showed that higher RD was associated with the higher odds of reporting poor or very poor health, both directly and indirectly through psychological stress. This association was observed irrespective of the geographic scale at which reference groups were defined.     

Beyond debt. A moderator analysis of the relationship between perceived financial strain and mental health

Heavy debt not only has economic consequences, but has also been related to severe psychological and physical distress. The present study investigates the relationship between perceived financial strain and mental health, and individual-level variables that moderate this relationship. Specifically it was expected that employment, access to the latent benefits of work, and self-efficacy would buffer the relationship between perceived financial strain and mental health. In a 2009 study conducted in Austria, among 106 people on the verge of bankruptcy, perceived financial strain appeared as the strongest predictor of distress. This effect was moderated by two out of five latent benefits of work and self-efficacy, but employment status failed to have a significant effect. The findings show the importance of subjective economic stress for the prediction of mental health among people in serious financial strain and indicate significant moderators of this relationship.